Rural health care

Country doc, city doc

Rural America needs more doctors

JASON DEES was raised in New Albany, Mississippi, the seat of rural Union County, in the north-central part of the state. He moved away for college and medical school, then moved back to start a family medical practice in 2003, and has since found that “one of the most exciting things about rural family medicine is that you spend your life taking care of people you really care about…the reward comes through the joy of caring for patients.”

That is good, because the reward of being a family doctor certainly is not monetary—at least not when compared with the stratospheric salaries of medical specialists. The average family doctor earns $175,000 a year (admittedly hardly a pauper's wage), compared with $385,000 for oncologists, $417,000 for radiologists and $519,000 for orthopaedic surgeons, according to Merritt Hawkins, a physician placement service. Small wonder that only around 9% of American medical-school graduates choose family practice (general practice, in British parlance)—a rate that according to the American Academy of Family Physicians will leave the country short of around 40,000 family doctors by 2020.

In all, around 65m Americans live in federally-designated primary-care health-professional shortage areas (HPSAs), which are regions with 2,000 or more residents per primary-care doctor. The paucity of family doctors naturally has a particularly strong impact on rural communities, which are home to around one-fifth of America's population but only one-tenth of its doctors, most of whom practise family medicine. In Georgia, for instance, which is a heavily agricultural state, there are medically underserved areas or populations in 144 of the state's 159 counties. America's rural population tends to be older and poorer than average, with higher rates of smoking and obesity, and consequently in greater need of medical care; by virtue of geography people living in rural HPSAs are often farther from medical care than urban ones.

Federal funding provides some help: some doctors who practise in underserved areas are eligible for higher reimbursements from Medicare—a particular draw for rural doctors, as people outside metropolitan regions are more likely to be uninsured than their big-city counterparts. And Barack Obama's new health-reform bill provides increased funding for primary-care residencies and for medical schools likely to train rural doctors. It also provides $9.5 billion over the next five years for clinics and health centres catering to underserved patients.

There are also state incentives: in Georgia, Mercer University's medical school trains students specifically for underserved and rural parts of Georgia, while the state's oldest medical school, Medical College of Georgia, has a campus in the rural south-western part of the state. According to William Bina, who heads Mercer's medical school, there are around 400 Mercer-trained doctors working in rural or underserved parts of the state. Perhaps the most effective incentive, available through federal and many state programmes, is loan forgiveness for medical graduates who work in underserved areas—hardly surprising, since the average medical student graduates with debts of $155,000.